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Trump has a new plan to kill Obamacare, and it could work

2017-10-12 |
The Charlotte Observer

The following editorial appeared in The Charlotte Observer on Thursday, Oct. 12:

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Donald Trump has a new way to get rid of Obamacare. This one comes without the humiliating defeats previous repeal efforts have suffered in Congress. It also might dodge the political outcry that preceded those defeats.

It's a bad idea, however, and not only because Trump's new idea would do the same thing as Republicans' old ideas _ destabilize insurance markets and cost millions of Americans benefits and coverage. It's a bad idea because one man shouldn't solely decide significant domestic policy.

Trump, according to the Wall Street Journal, is planning an executive action that instructs three agencies to rewrite health insurance regulations. The primary focus of the rewrite will likely be "association health plans," or AHPs, which are plans that insurers sell to groups that represent millions of self-employed individuals, small business employees or members of voluntary organizations such as trade groups.

Under the Affordable Care Act, AHP plans are subject to the same regulations as other insurance plans. They must cover "essential benefits" like mental health care, some doctor visits and maternity care. They also can't charge people more because they have pre-existing conditions.

Trump's executive action would make AHPs exempt from at least some Obamacare rules. That would create cheaper plans for businesses and individuals who don't want all of Obamacare's coverage or protections. Republicans have been pushing for such options for consumers since the ACA was enacted.

Those alternatives, however, would fracture the current insurance market, experts say. Small businesses and healthy individuals in AHPs would gravitate toward the cheaper plans, and other businesses and individuals would leave the ACA market to join AHPs and do the same. Sicker people would stay on the exchanges, which would then become more expensive for insurers and prompt them to drop out. The result: The ACA would become a hollowed-out high-risk pool and perhaps collapse. Millions would lose coverage and protections for pre-existing conditions.

All of which should sound familiar. It's what would've happened if Republicans had passed a repeal and replace health care bill. But with executive action, Republicans don't have to go through debates (such as they were) or the onslaught of bad publicity leading up to a high-pressure vote. The president can skip most, if not all, of the hassle with a few strokes of an Oval Office pen.

Doing so would surely invite court challenges, but experts thus far think Trump has at least some authority to loosen AHP regulations or allow states the discretion to do so. (Sen. Rand Paul also has lobbied the president to allow AHPs to be sold across state lines, regardless of state regulations. That would be a likely violation of current federal law; the White House has not indicated whether Paul's proposal is part of its plans.)

Another issue: Just as with Barack Obama's executive order on DACA recipients, we question whether President Trump should be setting health policy by fiat. No single person, not even the president, should solely determine significant domestic policy. That's the job of Congress, and it's a job Congress can and still should do by shoring up Obamacare and pre-empting the president's sabotage.